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Clinical trials that are designed to help inform practice in the real world are referred to as pragmatic trials. They are usually focused on the practical aspects of research design, like the recruitment and consent process, adherence, and the use of commonly available equipment.

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A pragmatic trial that uses a variety investigators and includes participants from different geographical areas is the Home Blood Pressure Management study (HBPM). This type of heterogeneity, which is vital for pragmatic trials to be valid and reduce bias in results, is also necessary. A high degree of heterogeneity, however can result in problems with the trial design.

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Pragmatic trials are designed to replicate real-world situations and have the highest external validity. They are typically requested by practitioners and policymakers to help inform their decisions. They also provide a useful method to determine the causality between an intervention and its results. However, they shouldn't be used as a substitute for the use of explanation studies.

The pragmatism idea is controversial and there are doubts about whether pragmatic trials can replace tests for explanations or if they are an addition to them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which confirm the clinical or physiological hypothesis, and pragmatic trials that inform the practice and policy decisions. They also suggested a framework known as PRECIS for pragmatic trials.2 This tool attempted to define the characteristics of a pragmatic research study that includes the recruitment, design, and delivery of the intervention and follow-up.

The number of pragmatic trials is growing. A recent Medline search using the keywords pragmatic and naturalistic, restricted to randomized controlled trials (RCTs) produced 34 articles, as shown in red in Figure 2. This indicates that the health sciences community is becoming more aware of the importance of pragmatic thinking. However, it is important to keep in mind that the majority of these studies were conducted in primary care settings.