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Trials designed to inform clinical practice in the real world are called pragmatic trials. They are often described by their focus on practical aspects of design, including the recruitment process and consent, adhering and the use of routinely available equipment.

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

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The purpose of pragmatic trials is to mimic real-life scenarios and to achieve maximum validity externally. They are usually requested by practitioners and policy makers to inform their decision making. They can also be a great way to identify the causal relationship between an intervention and its outcomes. However, they should not be used as a substitute for the use of explanation trials.

The pragmatism concept is controversial, and there are concerns about whether pragmatic trials should replace explanatory trials or complement them. Schwartz and Lellouch1 made a distinction between explanatory studies, which prove the validity of a physiological or clinical hypothesis, as well as pragmatic trials that aid in the decision-making process for policy and practice. They also suggested a framework for pragmatic trials, dubbed PRECIS.2 This tool was designed to define the characteristics of a pragmatic trial which includes the recruitment process, the design and delivery of the intervention, as well as monitoring.

The number of pragmatic trials is growing. A recent Medline search using the keywords pragmatic and naturalistic, restricted to randomized controlled trials (RCTs) produced 34 articles, which are shown in red in Figure 2. This is a sign that the health science community is becoming increasingly sensitized to the issue of pragmatics. However, it is important to note that the majority of these trials were conducted in primary care settings.