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However, they should not be used as a substitute for explanation trials. The pragmatism idea is controversial and there are doubts regarding whether pragmatic trials could replace explanatory tests or if they are an alternative to them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which validate a physiological or clinical hypothesis and pragmatic trials, which guide the policy and practice of. They also proposed a framework called PRECIS for pragmatic trials.2 The tool was designed to define the characteristics of a pragmatic study which includes recruitment, design, implementation of the intervention, and follow-up. There is a growing increase in the number of pragmatic trials that are published. A recent Medline search using the keywords pragmatic and naturalistic, restricted to controlled trials randomized to control (RCTs) resulted in 34 articles, shown in red in Figure 2. This indicates that the health sciences community is becoming more aware of the importance of pragmatic thinking. It is important to remember that the majority of these trials were conducted in primary care settings.
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