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Clinical trials that are designed to help inform practice in the real world are referred to as pragmatic trials. They are often described as focusing on practical aspects of design which include recruitment and consent, 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 used different investigators and participants from different geographic areas. This kind of heterogeneity, which is vital for a pragmatic trial to be valid and to reduce bias in the results, is also necessary. However too much heterogeneity could cause issues with the design of the trial.

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Pragmatic trials are designed to replicate real-life settings and achieve maximum external validity. Usually, they are ordered by policymakers and practitioners in order to inform their decisions. They can also be used to assess the cause-effect relationship of an intervention and its effects. However, they shouldn't be used as a substitute for explanatory trials.

The pragmatism idea is controversial and there are concerns regarding whether pragmatic trials could replace tests for explanations or if they should serve as an addition to them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which prove the clinical or physiological hypothesis as well as pragmatic trials that inform the policy and practice of. They also suggested an approach to pragmatic trials, which they called PRECIS.2 This tool sought to define the characteristics of a practical trial, including the recruitment process, the design and implementation of the intervention, as well as the follow-up.

The number of pragmatic trials is increasing. A recent Medline query that used the words pragmatic and naturalistic, limited to randomised controlled trials (RCTs), returned 34 articles. These are shown in red on Figure 2. This suggests that the health sciences community is becoming more aware of the importance of pragmatic thinking. It is important to note that the majority were conducted in primary-care settings.