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Trials designed to inform clinical practice in the real world are called pragmatic trials. They are typically described as a focus on the practical aspects of study design, including the recruitment process and consent, adhering 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 utilized various investigators and had participants from various geographical areas. This kind of heterogeneity, which is vital for pragmatic trials to be reliable and lessen the chance of bias, is also necessary. A high degree of heterogeneity, however, can cause problems with the design of the trial.

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Pragmatic trials are designed to replicate real-life settings and achieve maximum external validity. They are typically commissioned by policymakers and practitioners in order to inform their decisions. They are also a good method to determine the causal relationship between an intervention and its outcomes. However, they should not be used to replace explanation studies.

The pragmatism idea is controversial and there are doubts about whether pragmatic trials can replace explanatory tests or if they should serve as a complement to them. Schwartz and Lellouch1 suggested the distinction between explanatory 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 suggested a framework dubbed PRECIS for pragmatic trials.2 This tool tried to define the traits of a pragmatic study which includes recruitment, design, delivery of the intervention, and follow-up.

There is a growing trend in the number of pragmatic trials that have been published. A recent Medline search using the terms pragmatic and naturalistic, restricted to randomized controlled trials (RCTs) resulted in 34 articles, shown in red in Figure 2. This indicates that the health sciences community has become more aware of the importance of pragmatism. It is important to remember that the majority of these studies were conducted in primary care settings.