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However, they should not be used to replace explanatory studies.<br><br>The pragmatism concept is controversial, and there are questions about whether pragmatic trials should be used to replace explanatory trials or complement them. Schwartz and Lellouch1 suggested a distinction between explanatory trials, which prove the clinical or physiological hypothesis as well as pragmatic trials that inform the policy and practice of. They also suggested a framework known as PRECIS for pragmatic trials.2 The tool was designed to define the elements of a practical study, including the recruitment, design, and delivery of the intervention, and follow-up.<br><br>There is a growing increase in the number pragmatic trials published. A recent Medline query using the keywords pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs) returned 34 articles. These are highlighted in red on Figure 2. 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