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Studies designed to provide insight into clinical practice in the real world are called pragmatic trials. They are typically described by their focus on practical aspects of designing a study which include the recruitment process and consent, adhering and the use of standard equipment.

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Another example of a trial that is pragmatic is the Home Blood Pressure Management (HBPM) study, which used a variety of investigators and had participants from different geographical regions. This kind of heterogeneity is essential for pragmatic trials to be able to prove their validity, and it also reduces bias in the results. However, too much heterogeneity could cause issues with the design of the trial.

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Pragmatic trials aim to mimic real-life situations and attain maximum external validity. They are usually ordered by policymakers and practitioners to help inform their decisions. They can also be a great method to determine the causality between the intervention and its effects. However, they should not be used to replace explanation studies.

The pragmatism idea is controversial, and there are questions regarding whether pragmatic trials could replace tests for explanations or if they are a complement to them. Schwartz and Lellouch1 suggested an distinction between explanation-based studies, which confirm the physiological hypothesis or clinical hypothesis, as well as pragmatic trials, that inform the decision-making process for policy and practice. They also suggested a framework for pragmatic trials, which they called PRECIS.2 This tool attempted to define the elements of a pragmatic trial, including the recruitment process, the design and implementation of the intervention, as well as the follow-up.

The number of pragmatic trials is growing. A recent Medline query that used the words pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs), returned 34 articles. These are highlighted in red on Figure 2. This indicates that the health science community is becoming more acquaint to the issue of pragmatics. However, it is important to note that the majority of these trials were conducted in primary care settings.