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Another way of framing the difference between Explanatory and pragmatic trials is the trade-off between internal and external validity (Godwin et al 2003).
Participants--As pragmatic trials aim to test a treatment approach in a normal clinical environment their participants tend to be more heterogeneous than in explanatory trials (Helms 2002).
Treatment, Comparison and Control groups--One of the triggering factors in the evolution of pragmatic trials was the ethical and practical difficulties of a placebo (sham treatment) group in many healthcare trials (Helms 2002).
Pragmatic trials are well suited to situations where blinding is difficult or impossible (Helms 2002).
In contrast, outcomes in pragmatic trials reflect real world concerns such as return to work, pain levels, indices of function and cost analysis.
Pragmatic trials accept that non-compliant patients are part of the population and thus include the data from noncompliant compliant participants along with other participants in the analysis (Herbert et al 2005,pg92-101).
Why are pragmatic trials generally more suitable than explanatory trials in the assessment of physiotherapy interventions?
McMahon A (2002): Study control, violators, inclusion criteria and defining explanatory and pragmatic trials. Statistics in Medicine 21: 1365-1376.
The CONSORT Work Group on Pragmatic Trials (Zwarenstein et al.
An alternative might be to develop additional items more directly linked to the CONSORT Work Group on Pragmatic Trials recommended reporting criteria (Zwarenstein et al.
"Improving the Reporting of Pragmatic Trials: An Extension of the CONSORT Statement." British Medical Journal 337: a2390, doi: 10.1136/bmj