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Clinical trials that are designed to help inform practice in the real world are known as pragmatic trials. They are often described by their focus on practical aspects of study design that include the recruitment and consent process, as well as adherence and the use of standard equipment.

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A pragmatic trial that uses a variety investigators and includes participants from various geographical regions is the Home Blood Pressure Management study (HBPM). This type of heterogeneity, which is vital for a pragmatic trial to be reliable and reduce bias in results, is also necessary. However, too much heterogeneity can result in problems with the trial design.

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The aim of pragmatic trials is to simulate real-life scenarios and gain the highest level of validity externally. Usually, they are requested by practitioners and policymakers to guide their decisions. They are also a good method to determine the causality between an intervention and its results. However, they should not, be used to replace explanatory studies.

The pragmatism idea is controversial, and there are questions about whether pragmatic trials can replace explanatory tests or if they should be an addition to them. Schwartz and Lellouch1 suggested the distinction between explanatory trials, which confirm a physiological or clinical hypothesis as well as pragmatic trials, which inform policy and practice decisions. They also proposed a framework called PRECIS for pragmatic trials.2 This tool attempted to define the traits of a pragmatic study which includes the recruitment, design, and delivery of the intervention and follow-up.

The number of pragmatic trials is increasing. A recent Medline search using the words pragmatic and naturalistic, limited to randomised controlled trials (RCTs) returned 34 articles. These are shown in red on Figure 2. This is a sign that the health science community is becoming more acquaint to the issue of pragmatism. It is important to remember that the majority of these studies were conducted in primary care settings.