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Clinical trials that are designed to help inform practice in the real world are referred to as pragmatic trials. They are often focused on the practical aspects of study design, such as recruitment and consent as well as adherence to the use of routinely available equipment.

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Another example of a pragmatic trial is the Home Blood Pressure Management (HBPM) study, which employed various investigators and included participants from different geographical regions. https://www.metooo.es/u/66e5754cb6d67d6d177d7695 of heterogeneity, which is vital for a pragmatic trial to be reliable and reduce bias in results, is also necessary. However too much heterogeneity could lead to 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 requested by practitioners and policymakers to help guide their decisions. They also provide a useful way to identify the causal relationship between the intervention and its effects. However, they should not be used as a substitute for explanatory trials.

The pragmatism idea is controversial, and there are questions regarding whether pragmatic trials could replace tests for explanations or if they should be an alternative to them. Schwartz and Lellouch1 suggested a distinction between explanatory trials, which prove the validity of a clinical or physiological hypothesis, and pragmatic trials, which inform policy and practice decisions. They also proposed an approach to pragmatic trials, which they called PRECIS.2 This tool was designed to define the elements of a pragmatic trial which includes the recruitment process, the design and delivery of the intervention, and follow-up.

There is an encouraging trend in the number of pragmatic trials that have been published. A recent Medline query using the keywords pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs), returned 34 articles. They are displayed in red on Figure 2. This indicates that the health sciences community is becoming more sensitive to the issue of pragmatic thinking. It is important to keep in mind that the majority of studies were conducted in primary-care settings.