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Trials designed to inform clinical practice in the real world are known as pragmatic trials. They are often characterized as a focus on the practical aspects of study design which include the recruitment process and consent, adhering and the use of routinely available equipment.

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A pragmatic trial that uses various investigators and participants from different geographical areas is the Home Blood Pressure Management study (HBPM). This type of heterogeneity, which is essential for pragmatic trials to be valid and lessen the chance of bias is also essential. However, too much heterogeneity can result in problems with the trial design.

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The aim of pragmatic trials is to simulate real-life scenarios and gain maximum credibility externally. They are typically commissioned by practitioners and policy makers to inform their decision making. They can also be a great way to identify the causal relationship between the intervention and its effects. However, they shouldn't be used as a substitute for explanatory studies.

The concept of pragmatism is controversial, and there are doubts about whether pragmatic trials should replace or complement them. Schwartz and Lellouch1 suggested a distinction between explanatory trials, which prove the clinical or physiological hypothesis as well as pragmatic trials, which guide policy and practice decisions. They also proposed a framework called PRECIS for pragmatic trials.2 The tool was designed to define the characteristics of a pragmatic research study, including the recruitment, design, and delivery of the intervention, and follow-up.

The number of pragmatic trials is growing. A recent Medline query that used the words pragmatic and naturalistic, limited to randomised controlled trials (RCTs) returned 34 articles. These are shown in red on Figure 2. This is an indication that the health science community is becoming increasingly sensitized to the subject of pragmatism. However, it is important to note that the majority of these trials were conducted in primary care settings.