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Pragmatic trials are studies designed to inform the practice of clinical trials in real life. They are often described as focusing on practical aspects of study design that include 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 a variety of investigators and had participants from different geographic areas. This kind of heterogeneity is necessary for pragmatic trials to be valid and helps to reduce bias in the results. However, too much heterogeneity, can cause problems with the trial design.

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Pragmatic Play has gained a reputation for offering top-notch games and an exceptional user experience. Its software is accessible on mobile devices as well as in various languages. Despite its relatively young age it has established itself as a leading gaming platform for casinos. Wolves is one of the latest games, a 5-reel slot machine with a healthy RTP and stunning graphics. Other notable games include Wolf Gold and Chilli Heat.

The goal of pragmatic trials is to simulate real-life scenarios and to achieve maximum credibility externally. They are usually requested by practitioners and policy makers to inform their decision making. They also provide a useful method of determining the causality between an intervention and its results. However, they should not be used as a substitute for the use of explanation trials.

The idea of pragmatism is controversial and there are doubts regarding whether pragmatic trials could replace explanatory tests or if they should be an addition to them. Schwartz and Lellouch1 made the distinction between explanation studies, which support a physiological hypothesis or clinical hypothesis, and pragmatic trials that aid in the decision-making process for policy and practice. They also suggested an approach to pragmatic trials, called PRECIS.2 This tool was designed to define the features of a pragmatic study, including the recruitment process, the design and implementation of the intervention, as well as the follow-up.

The number of pragmatic trials is increasing. A recent Medline search using the keywords naturalistic and pragmatic, which was limited to controlled trials that are randomized (RCTs) resulted in 34 articles, which are shown in red in Figure 2. This is an indication that the health science community is becoming more sensitive to the issue of pragmatism. It is important to remember that the majority of studies were conducted in primary-care settings.