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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 as focusing on practical aspects of designing a study, including recruitment and consent, adherence and the use routinely available equipment.

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Pragmatic is a software development company that provides a variety of casino games for online gambling platforms. Its iGaming software is used by top operators and land based casinos. The company offers front-end design tools, analysis, marketing, promotions payment systems, security, customer service and bug reporting. In addition, the company provides its players a secure environment that features high-quality graphics and gameplay.

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Another example of a pragmatic trial is the Home Blood Pressure Management (HBPM) study, which used different investigators and included participants from different geographic areas. This kind of heterogeneity is necessary for pragmatic trials to be valid and helps to reduce the chance of bias in the results. 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 commissioned by policy makers and practitioners to guide their decision-making. They also provide a useful way to identify the causality between an intervention and its results. They should, however, not, be used to replace explanation studies.

The concept of pragmatism is controversial and there are doubts about whether pragmatic trials should replace or complement them. Schwartz and Lellouch1 suggested a distinction between explanatory studies, which support a physiological hypothesis or clinical hypothesis, as well as pragmatic trials, that inform the decision-making process for policy and practice. They also suggested a framework known as PRECIS for pragmatic trials.2 This tool attempted to define the elements of a pragmatic study which includes recruitment, design, implementation of the intervention and follow-up.

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