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Clinical trials that are designed to help inform practice in the real world are known as pragmatic trials. They are typically focused on the practical aspects of the research design, like the recruitment process and consent, adherence, and the use of standard equipment.

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A pragmatic trial that uses a variety investigators and includes participants from diverse geographical locations is the Home Blood Pressure Management study (HBPM). This kind of heterogeneity, that is crucial for a pragmatic trial to be reliable and reduce bias in results, is also necessary. However excessive heterogeneity could result in issues with the design of the trial.

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Pragmatic trials aim to mimic real-world situations and have the highest external validity. They are typically ordered by policymakers and practitioners to inform their decisions. They can also be a great way to identify the causality between an intervention and its outcomes. However, they shouldn't be used as a substitute for the use of explanation trials.

The concept of pragmatism is controversial and there are doubts regarding whether pragmatic trials could replace explanatory tests or if they should serve as an addition to them. Schwartz and Lellouch1 made an distinction between explanation-based studies, which prove a physiological hypothesis or clinical hypothesis, and pragmatic trials, which inform policy and practice decision-making. They also suggested a framework known as PRECIS for pragmatic trials.2 This tool attempted to define the characteristics of a pragmatic research study that includes the recruitment, design, and delivery of the intervention and follow-up.

The number of pragmatic trials is increasing. A recent Medline query that used the words pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs), returned 34 articles. These are highlighted in red on Figure 2. This indicates that the health sciences community has become more aware of the importance of pragmatism. However, it is important to remember that the majority of these trials were conducted in primary care settings.