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Studies designed to provide insight into clinical practice in the real world are called pragmatic trials. They are typically focused on the practical aspects of study design, including the recruitment and consent process in adherence, as well as the use of routinely available equipment.

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Another example of a practical trial is the Home Blood Pressure Management (HBPM) study, which utilized a variety of investigators and had participants from various geographical areas. This type of heterogeneity which is essential for a pragmatic trial to be valid and reduce bias in results is also essential. However, too much heterogeneity could cause issues with the design of the trial.

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The purpose of pragmatic trials is to simulate real-life scenarios and gain maximum credibility externally. Usually, they are requested by practitioners and policymakers in order to inform their decisions. They also provide a useful way to identify the cause-effect relationship between an intervention and its outcomes. However, they should not, be used to replace explanation studies.

The pragmatism idea is controversial, and there are questions regarding whether pragmatic trials could be used to replace explanation tests or if they are an alternative to them. Schwartz and Lellouch1 suggested a distinction between explanatory studies, which confirm the physiological hypothesis or clinical hypothesis, and pragmatic trials, that inform the decision-making process for policy and practice. They also proposed an approach to pragmatic trials, called PRECIS.2 This tool sought to define the characteristics of a pragmatic trial that include the recruitment process, the design and implementation of the intervention, as well as follow-up.

There is an encouraging increase in the number pragmatic trials that have been published. A recent Medline search using the terms naturalistic and pragmatic, which was limited to randomized controlled trials (RCTs) resulted in 34 articles, as shown in red in Figure 2. This suggests that the health sciences community has become more aware of the importance of pragmatic thinking. It is important to keep in mind, however, that the majority of studies were conducted in primary-care settings.