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Trials designed to inform clinical practice in the real world are referred to as pragmatic trials. They are typically characterized by a focus on the practical aspects of the research design, like the recruitment process and consent as well as adherence to the use of commonly available equipment.

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Another example of a pragmatic trial is the Home Blood Pressure Management (HBPM) study, which used different investigators and included participants from different geographical regions. This type of heterogeneity is essential for pragmatic trials to be able to prove their validity and helps to reduce the chance of bias in the results. A high degree of heterogeneity, however can result in problems with the design of the trial.

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The aim of pragmatic trials is to simulate real-life situations and achieve maximum credibility externally. Usually, they are commissioned by policymakers and practitioners in order to guide their decisions. They are also a good method of determining the causality between an intervention and its results. They should, however, not, be used to replace the need for explanation studies.

The concept of pragmatism is controversial, and there are questions regarding whether pragmatic trials could replace explanatory tests or if they are a complement to them. Schwartz and Lellouch1 suggested the distinction between explanatory trials, which prove the 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 The tool was designed to define the elements of a pragmatic study that includes recruitment, design, delivery of the intervention and follow-up.

There is a positive increase in the number of pragmatic trials that are published. A recent Medline query that used the words pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs), returned 34 articles. These are shown in red on Figure 2. This indicates that the health sciences community is becoming more aware of the importance of pragmatic thinking. However, it is important to note that the majority of these studies were conducted in primary care settings.