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However, they should not be used as a substitute for explanatory trials. The concept of pragmatism is controversial, and there are questions about whether pragmatic trials should replace explanatory tests or if they should be an alternative to them. Schwartz and Lellouch1 made the distinction between explanation studies, which confirm a 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 This tool attempted to define the traits of a pragmatic research study that includes recruitment, design, delivery of the intervention and follow-up. The number of pragmatic trials is increasing. A recent Medline search using the keywords pragmatic and naturalistic, restricted to controlled trials randomized to control (RCTs) produced 34 articles, which are shown in red in Figure 2. This indicates that the health sciences community has become more aware of the importance of pragmatism. It is important to note, however, that the majority of studies were conducted in primary-care settings.
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