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Trials designed to inform clinical practice in the real world are known as pragmatic trials. They are typically described by their focus on practical aspects of designing a study which include the recruitment process and consent, adhering and the use routinely available equipment.

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Another example of a practical trial is the Home Blood Pressure Management (HBPM) study, which used different investigators and participants from different geographic areas. This type of heterogeneity is essential for pragmatic trials to be able to prove their validity, and it also reduces bias in the results. However too much heterogeneity could cause problems with the design of the trial.

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Pragmatic Play has earned a reputation for providing top-notch games and an exceptional user experience. Its software is designed to work with mobile devices and supports various languages. Despite its infancy it has already established itself as a leading casino gaming platform. Wolves is one of the most recent releases, a 5-reel slot machine with a hefty RTP and stunning graphics. Other notable titles include Wolf Gold and Chilli Heat.

Pragmatic trials aim to mimic real-life situations and attain maximum external validity. They are typically requested by practitioners and policymakers to help inform their decisions. They can also be a great way to identify the cause-effect relationship between an intervention and its outcomes. However, they shouldn't be used as a substitute for explanation trials.

The concept of pragmatism is controversial, and there are questions about whether pragmatic trials should replace tests for explanations or if they should be an addition to them. Schwartz and Lellouch1 suggested an distinction between explanation-based studies, which prove a physiological hypothesis or clinical hypothesis, and pragmatic trials, that inform the decision-making process for policy and practice. They also suggested a framework known as PRECIS for pragmatic trials.2 The tool was designed to define the elements of a pragmatic research study, including the recruitment, design, and delivery of the intervention, and follow-up.

The number of pragmatic trials is growing. A recent Medline search using the terms naturalistic and pragmatic, limited to controlled trials that are randomized (RCTs) produced 34 articles, which are shown in red in Figure 2. This is a sign that the health science community is becoming more acquaint to the issue of pragmatism. It is important to keep in mind, however, that the majority of these studies were conducted in primary-care settings.