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Pragmatic trials are studies designed to inform real-world clinical practice. They are typically described as focusing on practical aspects of study design which include the recruitment process and consent, adhering and the use routinely available equipment.

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A practical trial that employs a variety investigators and includes participants from various geographical regions is the Home Blood Pressure Management study (HBPM). This type of heterogeneity that is crucial for pragmatic trials to be valid and lessen the chance of bias is also essential. A high degree of heterogeneity, however, can cause problems with the design of the trial.

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The aim of pragmatic trials is to simulate real-life scenarios and gain maximum credibility externally. They are usually ordered by policymakers and practitioners in order to guide their decisions. They can be used to determine the cause-effect relationship of an intervention with its outcomes. They should, however, not, be used to replace explanation studies.

The pragmatism concept is controversial, and there are doubts about whether pragmatic trials should replace or complement them. Schwartz and Lellouch1 suggested the distinction between explanatory trials, which confirm the validity of a clinical or physiological hypothesis and pragmatic trials, which inform the policy and practice of. They also proposed a framework for pragmatic trials, dubbed PRECIS.2 This tool was designed to define the characteristics of a pragmatic trial which includes recruitment, design and delivery of the intervention, as well as monitoring.

There is an encouraging increase in the number of pragmatic trials that are published. A recent Medline search using 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 sciences community is becoming more aware of the importance of pragmatism. However, it is important to note that the majority of these trials were conducted in primary care settings.