Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comment
. 2009 May 12;180(10):1001-3.
doi: 10.1503/cmaj.090076. Epub 2009 Apr 16.

Explaining pragmatic trials to pragmatic policy-makers

Malcolm Maclure  1
Affiliations
Comment

Explaining pragmatic trials to pragmatic policy-makers

Malcolm Maclure. CMAJ. .
No abstract available

PubMed Disclaimer

Figures

Figure 1
Figure 1
Ten major dimensions of an explanatory (intervention) trial that influence the trial’s applicability as it moves from its purpose to its result (from left to right). The dimensions can be divided between the provider of the intervention (e.g., clinician) and its target recipient who normally receives standard care (e.g., patient). See Figure 3 for examples of other providers and recipients.
Figure 2
Figure 2
Ten major dimensions of a pragmatic trial showing real-world variation. In contrast to the restrictions on these dimensions in explanatory trials, as illustrated in Figure 1, pragmatic trials incorporate greater diversity in selection of providers and recipients, flexibility of the intervention, degrees of adherence, scrutiny of participants, and types of outcomes and analyses. Pragmatic trials are more likely to have multiple purposes, addressed by multiple analyses.
Figure 3
Figure 3
The providers need not be clinicians and the recipients need not be patients. Often the units of intervention and outcome analysis — like the cause and the effects — are at other levels in the health system hierarchy.
See this image and copyright information in PMC

Comment in

  • What kind of randomized trials do we need?
    Zwarenstein M, Treweek S. Zwarenstein M, et al. CMAJ. 2009 May 12;180(10):998-1000. doi: 10.1503/cmaj.082007. Epub 2009 Apr 16. CMAJ. 2009. PMID: 19372438 Free PMC article. No abstract available.

Comment on

References

    1. Thorpe KE, Zwarenstein M, Oxman AD, et al. A pragmatic–explanatory continuum indicator summary (PRECIS): a tool to help trial designers. J Clin Epidemiol. 2009;62:464–75. [Also in CMAJ 2009;180:1025–32.] - PubMed
    1. Karanicolas PJ, Montori VM, Deveraux PJ, et al. A new “Mechanistic–Practical” framework for designing and interpreting randomized trials. J Clin Epidemiol. 2009;62:479–84. - PubMed
    1. Oxman AD, Lombard C, Treweek S, et al. Why we will remain pragmatists: four problems with the impractical mechanistic framework and a better solution. J Clin Epidemiol. 2009;62:485–8. - PubMed
    1. Schwartz D, Lellouch J. Explanatory and pragmatic attitudes in therapeutical trials. J Chronic Dis. 1967;20:637–48. [Reprinted in J Clin Epidemiol 2009;62:499–505.] - PubMed
    1. Wiener PP, editor. The dictionary of the history of ideas: studies of selected pivotal ideas. Vol. 3. New York (NY): Charles Scribner’s Sons; 1973. Pragmatism; pp. 551–70.