Do randomized controlled nursing trials have a pragmatic or explanatory attitude? Findings from the Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) tool exercise

Abstract

Background: Randomized controlled trials (RCTs) may be categorized as either effectiveness trials or efficacy trials, which may be categorized by the Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) tool. However, no data regarding the application of the PRECIS tool in a cluster of RCTs belonging to a specific discipline such as nursing are available.

Purpose: The principal aim of this study was to assess the prevailing nature (pragmatic vs. explanatory) of a cluster of clinical nursing RCTs. Evaluating the suitability of the PRECIS in the analysis of nursing RCTs was the secondary aim.

Methods: All nursing RCTs published in 2010 were identified through a systematic review and extracted in full-text form. An explanatory-pragmatic (E-P) group consisting of 11 researchers trained in the use of the PRECIS tool evaluated each RCT in terms of 10 domains, respectively scored on a scale ranging from 5 (pragmatic) to 1 (explanatory). The E-P group further scored the feasibility of the PRECIS tool using a numerical rating scale (0 = not at all, 10 = entirely feasible).

Results: Along the pragmatic-explanatory continuum, assuming 50 as the highest degree of pragmatism and 10 as the highest degree of explanatory, the evaluation of nursing RCTs returned an average of 31.1 (median = 31, SD = 7.18, range = 13-44). On the pragmatic-explanatory continuum, the evaluated nursing RCTs tended to be pragmatic, which seems to be consistent with the purposes of the nursing discipline. The feasibility of the PRECIS tool in the evaluation of nursing trials as perceived by the E-P Group was, on average, 7.09 (SD = 1.09, 95% CI [6.35, 7.82]).

Conclusions/implications for practice: Applying the PRECIS tool is perceived to be highly feasible in the critical appraisal of a cluster of RCTs in a specific discipline such as nursing.