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However, they should 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 replace explanatory tests or if they are a complement to them. Schwartz and Lellouch1 suggested the distinction between explanatory trials, which validate a physiological or clinical hypothesis as well as pragmatic trials, which inform the policy and practice of. They also proposed a framework called PRECIS for pragmatic trials.2 This tool attempted to define the elements of a pragmatic research study, including recruitment, design, delivery of the intervention and follow-up. The number of pragmatic trials is increasing. A recent Medline query that used the words pragmatic and naturalistic, limited to randomised controlled trials (RCTs), returned 34 articles. These are highlighted in red on Figure 2. This is a sign that the health science community is becoming more sensitive to the issue of pragmatics. It is important to keep in mind that the majority of these studies were conducted in primary care settings.
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