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Pragmatic trials are studies designed to inform the practice of clinical trials in real life. They are often characterized by a focus on the practical aspects of the study design, such as the recruitment process and consent, adherence, and the use of commonly available equipment.

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Another example of a pragmatic trial is the Home Blood Pressure Management (HBPM) study, which employed a variety of investigators and participants from different geographical regions. This kind of heterogeneity is essential for pragmatic trials to be able to prove their validity and also reduces the chance of bias in the results. However too much heterogeneity could cause issues with the design of the trial.

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Pragmatic trials seek to replicate real-life situations and attain maximum external validity. Usually, they are requested by practitioners and policymakers to help inform their decisions. They also provide a useful method to determine the causal relationship between an intervention and its outcomes. However, they shouldn't be used to substitute for explanatory studies.

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

There is an encouraging increase in the number of pragmatic trials published. A recent Medline query that used the words pragmatic and naturalistic, which was restricted 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 subject of pragmatism. It is important to remember that the majority of studies were conducted in primary care settings.