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Trials designed to inform clinical practice in the real world are referred to as pragmatic trials. They are often described as focusing on practical aspects of designing a study, including the recruitment and consent process, as well as adherence and 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 employed various investigators and participants from different geographic areas. This kind of heterogeneity is essential for practical trials to be valid, and it also helps reduce the chance of bias in the results. However, too much heterogeneity can cause problems with the design of the trial.

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The aim of pragmatic trials is to simulate real-life scenarios and to achieve maximum credibility externally. They are usually ordered by policymakers and practitioners to help guide their decisions. They can also be used to assess the cause-effect relationship of an intervention with its outcomes. They should, however, not be used to replace the need for explanation studies.

The concept of pragmatism is controversial and there are doubts about whether pragmatic trials should be used to replace explanatory trials or complement them. Schwartz and Lellouch1 suggested the distinction between explanatory trials, which confirm a physiological or clinical hypothesis and pragmatic trials that inform policy and practice decisions. They also proposed an approach to pragmatic trials, called PRECIS.2 This tool was designed to define the characteristics of a practical trial which includes the recruitment process, the design and implementation of the intervention, and follow-up.

The number of pragmatic trials is increasing. A recent Medline search using the terms naturalistic and pragmatic, which was limited to randomized controlled trials (RCTs) resulted in 34 articles, 프라그마틱 플레이 shown in red in Figure 2. This is a sign that the health sciences community is becoming more sensitive to the subject of pragmatics. However, it is important to note that the majority of these trials were conducted in primary care settings.