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Clinical trials that are designed to help inform practice in the real world are known as pragmatic trials. They are often described by their focus on practical aspects of design which include the recruitment process and consent, adhering 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 utilized various investigators and had participants from different geographical regions. This kind of heterogeneity is essential for pragmatic trials to be able to prove their validity, and it also reduces the chance of bias in the results. However, too much heterogeneity can lead to problems with the design of the trial.

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Pragmatic Play is renowned for its top-notch games, and for offering an exceptional user experience. Its software is designed to work with mobile devices and supports various languages. Despite its relatively young age, it has already established itself as a premier casino gaming platform. Wolves is one of the most recent releases, a 5-reel slot machine with a healthy RTP and impressive graphics. Other notable titles include Wolf Gold and Chilli Heat.

Pragmatic trials seek to replicate real-world situations and have the highest external validity. They are typically ordered by policymakers and practitioners to inform their decisions. They can also be used to determine the causality of an intervention and its results. However, they shouldn't be used to substitute for the use of explanation trials.

The concept of pragmatism is controversial and there are doubts regarding whether pragmatic trials could be used to replace explanation tests or if they should be a complement to them. Schwartz and Lellouch1 suggested the distinction between explanatory trials, which validate the clinical or physiological hypothesis, and pragmatic trials, which guide the practice and policy decisions. They also suggested an approach to pragmatic trials, dubbed PRECIS.2 This tool was designed to define the characteristics of a pragmatic study that include recruitment, design and delivery of the intervention, and the follow-up.

The number of pragmatic trials is growing. A recent Medline query that used the words naturalistic and pragmatic, restricted to randomised controlled trials (RCTs), returned 34 articles. These are shown in red on Figure 2. This suggests that the health sciences community is becoming more aware of the importance of pragmatic thinking. It is important to note that the majority of these studies were conducted in primary care settings.

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