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Trials designed to inform clinical practice in the real world are called pragmatic trials. They are often described as focusing on practical aspects of design, including recruitment and consent, adherence and the use of standard equipment.

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Another example of a trial that is pragmatic is the Home Blood Pressure Management (HBPM) study, which used different investigators and included participants from different geographical regions. This kind of heterogeneity, which is vital for pragmatic trials to be valid and reduce bias in results is also essential. However, too much heterogeneity could cause issues with the trial design.

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The goal of pragmatic trials is to simulate real-life scenarios and to achieve maximum credibility externally. They are usually requested by practitioners and policymakers to help guide their decisions. They also provide a useful method of determining the causality between the intervention and its effects. They should not, however be used to replace the need for explanation studies.

The idea of pragmatism is controversial, and there are questions about whether pragmatic trials can replace tests for explanations or if they should serve as an addition to them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which prove a physiological or clinical hypothesis, and pragmatic trials, which inform policy and practice decisions. They also suggested a framework dubbed PRECIS for pragmatic trials.2 The tool was designed to define the traits of a pragmatic research study that includes recruitment, design, delivery of the intervention, and follow-up.

There is a growing increase in the number pragmatic trials that have been published. A recent Medline query using the keywords pragmatic and 프라그마틱 naturalistic, which was restricted to randomised controlled trials (RCTs), returned 34 articles. These are highlighted in red on Figure 2. This is an indication that the health sciences community is becoming more sensitive to the issue of pragmatism. It is important to note that the majority of these studies were conducted in primary care settings.