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Clinical trials that are designed to help inform practice in the real world are known as pragmatic trials. They are typically described by their focus on practical aspects of designing a study which include recruitment and consent, adherence and the use of routinely available equipment.

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A pragmatic trial that uses various investigators and participants from various geographical regions is the Home Blood Pressure Management study (HBPM). This type of heterogeneity, which is essential for a pragmatic trial to be reliable and lessen the chance of bias is also essential. However, too much heterogeneity can lead to problems with the design of the trial.

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Pragmatic trials aim to mimic real-world situations and have the highest external validity. They are usually ordered by policymakers and practitioners to help guide their decisions. They are also a good way to identify the cause-effect relationship between an intervention and its results. However, they should not be used as a substitute for explanatory studies.

The pragmatism concept is controversial, and there are concerns about whether pragmatic trials should be used to replace explanatory trials or complement them. Schwartz and Lellouch1 suggested the distinction between explanatory trials, which validate a physiological or clinical hypothesis, and pragmatic trials, which inform the policy and practice of. They also suggested a framework known as PRECIS for pragmatic trials.2 This tool attempted to define the traits of a pragmatic research study that includes recruitment, design, 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), yielded 34 articles, as shown in red in Figure 2. This is a sign that the health science community is becoming increasingly sensitized to the issue of pragmatism. However, it is important to note that the majority of these trials were conducted in primary care settings.