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Trials designed to inform clinical practice in the real world are called pragmatic trials. They are usually focused on the practical aspects of study design, such as recruitment and consent as well as adherence to the use of standard equipment.

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A practical trial that employs different investigators and participants from various geographical regions is the Home Blood Pressure Management study (HBPM). This type of heterogeneity, which is vital for a pragmatic trial to be reliable and lessen the chance of bias, is also necessary. However, too much heterogeneity can lead to problems with the design of the trial.

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The purpose of pragmatic trials is to mimic real-life scenarios and gain maximum credibility externally. Usually, they are commissioned by policymakers and practitioners in order to guide their decisions. They can also be used to determine the cause-effect relationship of an intervention and its results. However, they should not be used to replace explanatory studies.

The pragmatism idea is controversial, and there are questions regarding whether pragmatic trials could replace tests for explanations or if they should be an addition to them. Schwartz and Lellouch1 proposed a distinction between explanatory studies, which confirm the validity of a physiological or clinical hypothesis, as well as pragmatic trials, that inform the practice and policy decision-making. They also proposed an approach to pragmatic trials, called PRECIS.2 This tool was designed to define the elements of a pragmatic trial which includes the recruitment process, the design and implementation of the intervention, and monitoring.

There is a positive 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 indicates that the health sciences community is becoming more aware of the importance of pragmatism. However, it is important to keep in mind that the majority of these trials were conducted in primary care settings.