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Clinical trials that are designed to help inform practice in the real world are known as pragmatic trials. They are often described by their focus on practical aspects of design which include the recruitment and consent process, as well as adherence and the use of routinely available equipment.

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Another example of a practical trial is the Home Blood Pressure Management (HBPM) study, which employed various investigators and had participants from various geographical areas. This kind of heterogeneity, which is vital for a pragmatic trial to be valid and to reduce bias in the results is also essential. However, too much heterogeneity can result in problems with the design of the trial.

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The aim of pragmatic trials is to replicate real-life scenarios and to achieve the highest level of validity externally. Usually, they are requested by practitioners and policymakers to help inform their decisions. They are also a good method to determine the causal relationship between an intervention and its results. They should, however, not be used to replace explanatory studies.

The pragmatism idea is controversial, and there are questions about whether pragmatic trials should be used to replace explanation tests or if they should be an addition to them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which validate the validity of a clinical or physiological hypothesis and pragmatic trials that inform the practice and policy decisions. They also suggested a framework known as PRECIS for pragmatic trials.2 This tool tried to define the traits of a pragmatic study which includes recruitment, design, delivery of the intervention and its follow-up.

There is an encouraging increase in the number pragmatic trials that have been published. A recent Medline query that used the words naturalistic and pragmatic, restricted to randomised controlled trials (RCTs) returned 34 articles. They are displayed in red on Figure 2. This indicates that the health sciences community has become more aware of the importance of pragmatism. It is important to keep in mind that the majority of these trials were conducted in primary care settings.