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Clinical trials that are designed to help inform practice in the real world are called pragmatic trials. They are often described as focusing on practical aspects of designing a study, including the recruitment and consent process, as well as adherence and the use of routinely available equipment.

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

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The goal of pragmatic trials is to simulate real-life scenarios and gain the highest level of validity externally. Usually, they are commissioned by policymakers and practitioners to guide their decisions. They are also a good method of determining the causal relationship between an intervention and its outcomes. However, they shouldn't be used as a substitute for explanatory studies.

The idea of pragmatism is controversial and there are concerns regarding whether pragmatic trials could replace tests for explanations or if they are an addition to them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which validate the clinical or physiological hypothesis, and pragmatic trials, which guide the practice and policy decisions. They also proposed a framework called PRECIS for pragmatic trials.2 This tool tried to define the characteristics of a practical study which includes recruitment, design, implementation of the intervention, and follow-up.

The number of pragmatic trials is growing. A recent Medline query using the keywords naturalistic and pragmatic, restricted to randomised controlled trials (RCTs) returned 34 articles. These are shown in red on Figure 2. This indicates that the health sciences community is becoming more acquaint to the subject of pragmatics. It is important to note that the majority of these studies were conducted in primary care settings.