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Trials designed to inform clinical practice in the real world are called pragmatic trials. They are often focused on the practical aspects of the study design, including recruitment and consent, adherence, and the use of commonly available equipment.

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Another example of a trial that is pragmatic is the Home Blood Pressure Management (HBPM) study, which used various investigators and had participants from various geographical areas. This type of heterogeneity is necessary for pragmatic trials to be able to prove their validity and also helps reduce bias in the results. A high degree of heterogeneity, however, can cause problems with the design of the trial.

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The aim of pragmatic trials is to mimic real-life scenarios and gain maximum credibility externally. Usually, they are requested by practitioners and policymakers in order to guide their decisions. They can also be a great way to identify the causal relationship between an intervention and its results. However, they shouldn't be used in lieu 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 a distinction between explanatory studies, which confirm the validity of a physiological or clinical hypothesis, as well as pragmatic trials that aid in the decision-making process for policy and practice. They also suggested a framework dubbed PRECIS for pragmatic trials.2 This tool tried to define the traits of a pragmatic research study that includes recruitment, design, implementation of the intervention and follow-up.

There is an encouraging increase in the number pragmatic trials that are published. A recent Medline query using the keywords naturalistic and pragmatic, restricted to randomised controlled trials (RCTs) returned 34 articles. These are highlighted in red on Figure 2. This is an indication that the health sciences community is becoming increasingly sensitized to the subject of pragmatics. It is important to remember that the majority of these trials were conducted in primary care settings.