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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 as a focus on the practical aspects of designing a study which include the recruitment and consent process, as well as adherence and the use of routinely available equipment.

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A practical trial that employs various investigators and participants from various geographical regions is the Home Blood Pressure Management study (HBPM). This kind of heterogeneity, that is crucial for a pragmatic trial to be valid and to reduce bias in the results is also essential. However too much heterogeneity could result in problems with the design of the trial.

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The aim of pragmatic trials is to mimic real-life scenarios and to achieve maximum credibility externally. They are usually requested by practitioners and policymakers to guide their decisions. They can also be a great way to identify the causality between an intervention and its outcomes. However, they should not be used to replace the need for explanation studies.

The pragmatism idea is controversial, and there are doubts about whether pragmatic trials should replace explanatory trials or complement them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which confirm the validity of a clinical or physiological hypothesis and pragmatic trials, which guide the practice and policy decisions. They also suggested a framework known as PRECIS for pragmatic trials.2 This tool attempted to define the characteristics of a pragmatic study which includes recruitment, design, implementation of the intervention, and follow-up.

There is a positive trend in the number of pragmatic trials published. A recent Medline search using the words naturalistic and pragmatic, restricted to randomised controlled trials (RCTs) returned 34 articles. They are displayed in red on Figure 2. This suggests that the health sciences community has become more aware of the importance of pragmatism. It is important to keep in mind, however, that the majority of these studies were conducted in primary-care settings.