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Pragmatic trials are those that are designed to provide information for the practice of clinical trials in real life. They are often focused on the practical aspects of study design, such as recruitment and consent in adherence, as well as the use of routinely available equipment.

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A pragmatic study that involves a variety investigators and includes participants from various geographical regions is the Home Blood Pressure Management study (HBPM). This type of heterogeneity is necessary for practical trials to be valid, and it also helps reduce the chance of bias in the results. However too much heterogeneity could lead to issues with the design of the trial.

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The aim of pragmatic trials is to mimic real-life scenarios and gain the highest level of validity externally. They are typically requested by practitioners and policymakers in order to guide their decisions. They can also be used to assess the causal relationship between an intervention with its outcomes. However, they shouldn't be used in lieu for explanatory trials.

The pragmatism idea is controversial and there are concerns about whether pragmatic trials can replace explanatory tests or if they are an addition to them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which prove the validity of a clinical or physiological hypothesis, and pragmatic trials, which inform the policy and practice of. They also proposed a framework for pragmatic trials, dubbed PRECIS.2 This tool attempted to define the characteristics of a pragmatic study that include the recruitment process, the design and implementation of the intervention, and the follow-up.

There is a positive trend in the number of pragmatic trials that have been published. A recent Medline query using the keywords pragmatic and naturalistic, limited to randomised controlled trials (RCTs), returned 34 articles. These are highlighted in red on Figure 2. This indicates that the health science community is becoming more sensitive to the subject of pragmatics. It is important to remember that the majority of these trials were conducted in primary care settings.