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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 typically focused on the practical aspects of study design, such as the recruitment process and consent in adherence, as well as the use of commonly available equipment.

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A pragmatic study that involves a variety investigators and includes participants from different geographical areas is the Home Blood Pressure Management study (HBPM). This kind of heterogeneity is necessary for practical trials to be valid and also helps reduce bias in the results. However, too much heterogeneity can cause issues with the design of the trial.

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Pragmatic trials seek to replicate real-life situations and attain maximum external validity. Usually, they are requested by practitioners and policymakers in order to inform their decisions. They can also be a great method of determining the causal relationship between an intervention and its results. However, they shouldn't be used to substitute for the use of explanation studies.

The pragmatism idea is controversial, and there are questions about whether pragmatic trials should replace explanatory trials or complement them. Schwartz and Lellouch1 proposed the distinction between explanation studies, which support a physiological hypothesis or clinical hypothesis, as well as pragmatic trials that aid in policy and practice decision-making. They also suggested a framework dubbed PRECIS for pragmatic trials.2 The tool was designed to define the traits of a pragmatic research study that includes the recruitment, design, and delivery of the intervention and follow-up.

There is an encouraging trend in the number of pragmatic trials published. A recent Medline search using the terms naturalistic and pragmatic, limited to controlled trials randomized to control (RCTs) resulted in 34 articles, which are shown in red in Figure 2. This is a sign that the health sciences community is becoming more sensitive to the subject of pragmatics. It is important to note that the majority were conducted in primary care settings.