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Trials designed to inform clinical practice in the real world are called pragmatic trials. They are often characterized by their focus on practical aspects of designing a study that include recruitment and consent, adherence and the use routinely 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 necessary for practical trials to be valid and helps to reduce the chance of bias in the results. However, too much heterogeneity can lead to problems with the design of the trial.

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The goal of pragmatic trials is to replicate real-life scenarios and gain maximum credibility externally. They are usually commissioned by policymakers and practitioners to guide their decisions. They can also be a great method of determining the cause-effect relationship between an intervention and its results. They should, however, not, be used to replace the need for explanation studies.

The pragmatism idea is controversial, and there are questions about whether pragmatic trials should be used to replace explanatory trials or complement them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which validate the validity of a clinical or physiological hypothesis as well as pragmatic trials that inform the policy and practice of. They also proposed an approach to pragmatic trials, called PRECIS.2 This tool attempted to define the elements of a pragmatic study that include recruitment, design and delivery of the intervention, and monitoring.

There is a growing increase in the number pragmatic trials that have been published. A recent Medline search using the terms naturalistic and pragmatic, which was limited to randomized controlled trials (RCTs) produced 34 articles, as shown in red in Figure 2. This indicates that the health sciences community is becoming increasingly sensitized to the subject of pragmatic thinking. However, it is important to note that the majority of these studies were conducted in primary care settings.