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Trials designed to inform clinical practice in the real world are called pragmatic trials. They are often characterized by a focus on practical aspects of the research design, like recruitment and consent in adherence, as well as 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 utilized different investigators and participants from different geographic areas. This type of heterogeneity, which is essential for a pragmatic trial to be valid and to reduce bias in the results is also essential. However excessive heterogeneity could cause issues with the design of the trial.

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The goal of pragmatic trials is to mimic real-life situations and achieve maximum validity externally. They are usually requested by policy makers and practitioners to guide their decision-making. They can also be a great way to identify the cause-effect relationship between an intervention and its outcomes. However, they shouldn't be used in lieu for explanatory studies.

The pragmatism idea is controversial and there are doubts about whether pragmatic trials can replace explanatory tests or if they should be an alternative to them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which prove the validity of a clinical or physiological hypothesis and pragmatic trials that inform the practice and policy decisions. They also proposed the framework for pragmatic trials, called PRECIS.2 This tool was designed to define the features of a practical trial that include recruitment, design and delivery of the intervention, as well as follow-up.

The number of pragmatic trials is increasing. A recent Medline search using the keywords pragmatic and naturalistic, restricted to randomized controlled trials (RCTs) produced 34 articles, as shown in red in Figure 2. This suggests that the health sciences community is becoming more aware of the importance of pragmatism. However, it is important to note that the majority of these studies were conducted in primary care settings.