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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 described as focusing on practical aspects of design which include the recruitment process and consent, adhering and the use of standard equipment.

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A pragmatic study that involves different investigators and participants from diverse geographical locations is the Home Blood Pressure Management study (HBPM). This kind of heterogeneity, which is vital for pragmatic trials to be reliable and to reduce bias in the results is also essential. However, too much heterogeneity can result in problems with the design of the trial.

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Pragmatic trials are designed to replicate real-life situations and attain maximum external validity. They are usually requested by practitioners and policymakers in order to inform their decisions. They can also be used to assess the causal relationship between an intervention with its outcomes. However, they shouldn't be used as a substitute for explanation studies.

The concept of pragmatism is controversial and there are concerns about whether pragmatic trials should be used to replace explanatory trials or complement them. Schwartz and Lellouch1 suggested a distinction between explanatory trials, which prove the validity of a clinical or physiological hypothesis as well as pragmatic trials, which inform the policy and practice of. They also suggested a framework dubbed PRECIS for pragmatic trials.2 This tool tried to define the elements of a pragmatic research study, including recruitment, design, delivery of the intervention and its follow-up.

There is a growing increase in the number pragmatic trials that have been published. A recent Medline query that used the words pragmatic and naturalistic, limited to randomised controlled trials (RCTs), returned 34 articles. These are shown in red on Figure 2. This indicates that the health science community is becoming increasingly sensitized to the issue of pragmatic thinking. It is important to remember that the majority of these trials were conducted in primary care settings.