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Clinical trials that are designed to help inform practice in the real world are referred to as pragmatic trials. They are often characterized as a focus on the practical aspects of designing a study, including the recruitment and consent process, as well as adherence and the use routinely available equipment.

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Another example of a trial that is pragmatic is the Home Blood Pressure Management (HBPM) study, which used different investigators and included participants from various geographical areas. This type of heterogeneity is essential for practical trials to be valid and also helps to reduce the chance of bias in the results. However excessive heterogeneity could result in issues with the design of the trial.

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Pragmatic trials aim to mimic real-life settings and achieve maximum external validity. They are typically requested by practitioners and policymakers to help guide their decisions. They can also be a great method to determine the causality between an intervention and its results. However, they shouldn't be used to substitute for explanation trials.

The pragmatism idea is controversial and there are questions about whether pragmatic trials should replace explanatory trials or complement them. Schwartz and Lellouch1 suggested the distinction between explanatory trials, which prove a physiological or clinical hypothesis, and pragmatic trials, which inform policy and practice decisions. They also proposed a framework for pragmatic trials, dubbed PRECIS.2 This tool was designed to define the elements of a practical trial, including the recruitment process, the design and implementation of the intervention, and monitoring.

The number of pragmatic trials is growing. A recent Medline search using the keywords pragmatic and naturalistic, restricted to randomized controlled trials (RCTs), yielded 34 articles, shown in red in Figure 2. This indicates that the health science community is becoming more acquaint to the subject of pragmatic thinking. However, it is important to remember that the majority of these studies were conducted in primary care settings.