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Clinical trials that are designed to help inform practice in the real world are known as pragmatic trials. They are often characterized by a focus on the practical aspects of the study design, including the recruitment process and consent in adherence, as well as the use of commonly available equipment.

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A pragmatic study that involves various investigators and participants from different geographical areas is the Home Blood Pressure Management study (HBPM). This type of heterogeneity which is vital for a pragmatic trial to be valid and reduce bias in results, is also necessary. Too much heterogeneity, however could cause issues with the trial design.

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The purpose of pragmatic trials is to replicate real-life scenarios and gain maximum validity externally. Usually, they are ordered by policymakers and practitioners in order to inform their decisions. They can also be a great way to identify the cause-effect relationship between an intervention and its outcomes. However, they shouldn't be used in lieu for the use of explanation studies.

The concept of pragmatism is controversial, and there are doubts about whether pragmatic trials should replace or complement them. Schwartz and Lellouch1 suggested a distinction between explanatory trials, which validate the validity of a clinical or physiological hypothesis, and pragmatic trials, which guide policy and practice decisions. They also proposed an approach to pragmatic trials, which they called PRECIS.2 This tool attempted to define the elements of a pragmatic trial, including recruitment, design and delivery of the intervention, as well as the follow-up.

There is an encouraging increase in the number of pragmatic trials that have been published. A recent Medline query that used the words pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs) returned 34 articles. These are highlighted in red on Figure 2. This suggests that the health sciences community has become more aware of the importance of pragmatic thinking. However, it is important to remember that the majority of these trials were conducted in primary care settings.