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Clinical trials that are designed to help inform practice in the real world are called pragmatic trials. They are usually focused on the practical aspects of study design, including the recruitment and consent process in adherence, as well as the use of commonly available equipment.
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Pragmatic is a software company, offers a variety of casino games to online gambling platforms. Its iGaming software is used by top operators as well as land-based casinos. The company offers front-end site design tools, analysis tools and promotions, marketing, security, payment systems, customer support and bug reporting. The company also offers an environment that is safe and secure with high-quality graphics, gaming and security.
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A pragmatic trial that uses a variety investigators and includes participants from diverse geographical locations is the Home Blood Pressure Management study (HBPM). This kind of heterogeneity is necessary for practical trials to be valid and also helps reduce bias in the results. Too much heterogeneity, however could cause issues with the trial design.
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Pragmatic trials seek to replicate real-world situations and have the highest external validity. They are usually requested by practitioners and policy makers to guide their decision-making. They can also be used to assess the causal relationship between an intervention and its results. They should not, however, be used to replace the need for explanation studies.
The pragmatism concept is controversial and there are concerns about whether pragmatic trials should be used to replace explanatory trials or complement them. Schwartz and Lellouch1 made the distinction between explanation studies, which confirm the physiological hypothesis or clinical hypothesis, and pragmatic trials that aid in 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 practical study which includes recruitment, design, implementation of the intervention, and follow-up.
There is an encouraging increase in the number pragmatic trials published. A recent Medline search using the words naturalistic and pragmatic, restricted to randomised controlled trials (RCTs), returned 34 articles. These are shown in red on Figure 2. This indicates that the health sciences community is becoming more aware of the importance of pragmatic thinking. However, it is important to keep in mind that the majority of these studies were conducted in primary care settings.