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Trials designed to inform clinical practice in the real world are known as pragmatic trials. They are often characterized by a focus on the practical aspects of study design, such as the recruitment process and consent as well as adherence to 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 essential for pragmatic trials to be valid and lessen the chance of bias is also essential. However, too much heterogeneity can cause problems with the design of the trial.

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The goal of pragmatic trials is to simulate real-life scenarios and to achieve maximum credibility externally. They are usually requested by practitioners and policy makers to aid in their decision-making. They can also be a great way to identify the causality between an intervention and its outcomes. They should, however, not, be used to replace explanation studies.

The pragmatism idea is controversial, and there are questions about whether pragmatic trials can be used to replace explanation tests or if they should be a complement to them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which confirm the validity of a clinical or physiological hypothesis as well as pragmatic trials, which inform the practice and policy decisions. They also proposed a framework called PRECIS for pragmatic trials.2 The tool was designed to define the elements of a pragmatic study, including recruitment, design, implementation of the intervention and its 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, shown in red in Figure 2. This is an indication that the health science community is becoming increasingly sensitized to the subject of pragmatic thinking. However, it is important to note that the majority of these trials were conducted in primary care settings.